Hip sonography update. Quality-management, catastrophes - tips and tricks

Hip sonography is today considered to be the diagnostic standard tool for developmental dysplasia of the hip (DDH) diagnosis. In Germany special commissions control the quality of the sonograms according to checklists to keep the standard high and to avoid over- and under - treatment. This paper lists tips and tricks to avoid typical mistakes according to these results. In 8 German countries the quality of sonograms used to diagnose DDH was checked according to special checklists. An additional 250 medical doctors (pediatricians, radiologists, orthopaedic surgeons) were asked to classify 4 sonograms by measuring and typing. From the same group the projection (standing left, standing right, horizontal-cranial left, horizontal-cranial right) was checked according to the correct diagnosis in the shortest time. In 1.6 % - 43.7% the licence for hip sonography was withdrawn by the German commission. The best projection with the lowest rate of wrong interpretation was the "standing right"-projection. Most of the mistakes were made because of a wrong anatomical identification and usability check. Hip sonography must be trained by authorized teachers. The quality of the sonograms must be controlled according to checklists. The bedside teaching without control leads to a systematic teaching of mistakes and finally catastrophes.